Ultrasound 1: B-image presentation of an interuption of continuity in a otherwise homogenous image of the bone structure.

Ultrasound 2: B-image of an obvious fracture.

Diagnosis confirmation:

Total constellation (Consens)

Which DD would be also possible with the radiological findings:

normal cranial sutures, diploic veins, accessory suture.

Course / Prognosis / Frequency / Other :

Because of the nature of the accident, the assumption of a suture fracture was made. Radiologically, the diagnosis was proven using ultrasound. After initial hospitalisation and surveillance, the child was discharged into ambulatory care.

Comments of the author about the case:

Note from the author:The presentation of the cranial fractures with the help of high-resolution ultrasound is always better. Furthermore, the intracranial structures can be assessed if the fontanelles are open. This is particularly important in regard to an accompanying intracranial hemorrhage. It is possible that in the future one can completely disregard a conventional x-ray.

Note from the editors:The proof of a cranial fracture has per se no clinical worth, rather the proof of an intracerebral hemorrhage is most important. Therefore, a conventional x-ray is not needed in a case of a cranial trauma. This is because no therapeutic decisions are dependent on the proof (or missing proof) of a fracture.

The ultrasound: Seeing the fracture on the x-ray is almost always seen in the ultrasound as well; however the reverse (searching for fractures without an x-ray image) is often frustrating and often painful. In our opinion, sonography is not indicated in searching for fractures, but rather needed for ruling out a hemorrhage when the fontanelle is open.